MY AHIP EXAM QUESTIONS AND
CORRECT ANSWERS GRADED A+
FOR 2026 ASSURED EXAMS
ASSURED EXCEL!!
1. Mr.Gomez notes that a Private Fee for Service (PFFS) plan avaliable in his area has an
attractive preminum. He wants to know if he must use doctors in a network as his
current HMO plan requires him to do. What should you tell him? - CORRECT ANSWERS-
He may receive health care services from any doctor allowed to bill Medicare as long as
he shows the doctor the plan's identification card and the doctor agrees to accept the
PFFS plan's payment terms and conditions, which could include balance billing.
2. Mrs. Lee is discussing with you the possibility of enrolling in a Private Fee- for Service
(PFFS) plan. As part of that discussion, what should you be sure to tell her? - CORRECT
ANSWERS-PFFS plans may choose to offer Part D benefits but are not required to do so.
3. Mrs. Ramos is considering a Medicare Advantage PPO and has questions about which
providers she can go to for her health care. What should you tell her? - CORRECT
ANSWERS-Mrs. Ramos can obtain care from any provider who participates in Original
Medicare but generally will have a higher cost-sharing amount if she sees a provider
who/that is not apart of the PPO network.
4. Mr. McTaggert notes that a Private Fee for-Service (PFFS) plan avaliable in his area has an
attractive premium. He wants to know what makes them different from an HMO or a
PPO. What should you tell him? - CORRECT ANSWERS-Enrollees in a PFFS plan can
obtain care from any provider in the US who accepts Original Medicare, as long as the
provider has a reasonable opportunity to access the plan's terms and conditions and
agrees to accept them.
5. Mr. Castillo, a naturalized citizen, previously enrolled in Medicare Part B but has recently
stopped paying his Part B premium. Mr. Castillo is still covered by Part A. He would like
, to enroll in a Medicare Advantage (MA) plan and is still covered by Part A. What should
you tell him? - CORRECT ANSWERS-He is not eligible to enroll in a Medicare Advantage
plan until he re-enrolls in Medicare Part B.
6. Mr. Sinclar has diabetes and heart trouble and is generally satisified with the care he has
just received under Original Medicare, but he would like to know more about Medicare
Advantage Special Needs Plans (SNPs). What could you tell him? - CORRECT ANSWERS-
SNPs have special programs from enrollees with chronic conditions, like Mr. Sinclair and
they provide prescription drug coverage that could be very helpful as well.
7. Mrs.Davenport enrolled in the ABC Medicare Advantage (MA) plan several years ago.
Her doctor recently confirmed a diagnosis of end-stage renal disease (ESRD). What
options does Mrs.Davenport have regarding her MA plan during the next open
enrollment season? - CORRECT ANSWERS-She may remain in her ABC MA plan or enroll
in a Special Needs Plan (SNP) for individuals sufferinf from ESRD if one is available in her
area.
8. Daniel is a middle-income Medicare beneficiary. He has chronic bronchitis putting him at
severe risk for pneumonia. Otherwise, he has no problems functioning. Which type of
SNP is likely to be most appropriate for him? - CORRECT ANSWERS-C-SNP
9. Mr. Gomez notes that a Private Fee-for Service (PFFS) plan available in his area has an
attractive premium. He wants to know if he must use doctors in a network as his curreny
HMO plan requires him to do. What should you tell him? - CORRECT ANSWERS-He may
receive health care services from any doctor allowed to bill Medicare as long as he
shows the doctor the plan's identification card and the doctor agrees to accept the PFFS
plan's payment terms and conditions, which could include balance billing.
10. Mrs. Ramos is considering a Medicare Advantage PPO and has questions about which
providers she can go to for her health care. What should you tell her? - CORRECT
ANSWERS-Mrs. Ramos can obtain care from any provider who participates in Original
Medicare but generally will have a higher cost-sharing amount if she sees a provider
who/that is not a part of the PPO network.
,11. Mr. Kumar is considering a Medicare Advantage HMO and has questions about his ability
to access providers. What should you tell him? - CORRECT ANSWERS-In most Medicare
Advantage HMOs, Mr. Kumar must generally obtain his services only from providers who
have a contractual relationship with the plan (except in emergency or where care is
unavailable within the network)
12. Mr.Greco is in excellent health, lives in his own home, and has aa sizeable income from
his investments. He has a friend enrolled in a Medicare Advantage Special Needs Plan
(SNP). His friend has mentioned that the SNP charges very low costs sharing amounts
and Mr. Greco would like to join that plan. What should you tell him? - CORRECT
ANSWERS-SNPs limit enrollment to certain subpopulations of beneficiaries. Given his
current situation, he is unlikelt torqualifyrandrwouldrnotrberablertorenrollrinrtherSNP.
13. Dr.rElizabethrBrennanrdoesrnotrcontractrwithrtherPFFSrplanrbutrsheracceptsrtherplan'srterms
randrconditionsrforrpayment.rMaryrRodgersrseesrDr.rBrennanrforrtreatment.rHowrmuchrmay
rDr.rBrennanrcharge?r-rrCORRECTrANSWERS-
Dr.rBrennanrcanrchargerMaryrRodgersrnormorerthanrthercostrsharingrspecifiedrinrtherPFFSrpl
an'srtermsrandrconditionrofrpaymentrwhichrmayrincluderbalancerbillingruprtor15rpercentrofrt
herMedicarerrate.
14. Mrs.Lyonsrisrinrgoodrhealth,rusesrarsinglerprescription,randrlivesrindependentlyrinrherrownrh
ome.rSherisrattractedrbyrtheridearofrmaintainingrcontrolroverrarMedicalrSavingsrAccountr(M
SA)rbutrisrnotrsurerifrtherplanrassociatedrwithrtheraccountrwillrfitrherrneeds.rWhatrspecificrpi
ecerofrinformationraboutrarMedicarerMSArplanrwouldritrberimportantrforrherrtorknow,rpriorr
torenrollingrinrsuchrarplan?r-rrCORRECTrANSWERS-
AllrMSAsrcoverrPartrArandrPartrBrbenefits,rbutrnotrPartrDrprescriptionrdrugrbenefits,rwhichrc
ouldrberobtainedrbyralsorenrollingrinrarseparaterprescriptionrdrugrplan.
15. Mrs.LeerisrdiscussingrwithryourtherpossibilityrofrenrollingrinrarPrivaterFee-for-
Servicer(PFFS)rplan.rAsrpartrofrthatrdiscussion,rwhatrshouldryourbersurertortellrher?r-
rrCORRECTrANSWERS-
PFFSrplansrmayrchoosertorofferrPartrDrbenefitsrbutrarernotrrequiredrtordorso.
, 16. WhichrofrtherfollowingrstatementsrisrcorrectraboutrMedicarerSavingsrAccountr(MSA)rPlans?
r
17. I.rMSAsrmayrhavereitherrarpartialrnetwork,rfullrnetwork,rorrnornetworkrofrproviders
18. II.rMSArplansrcoverrPartrArandrPartrBrbenefitsrbutrnotrPartrDrprescriptionrdrugrbenefits.
19. III.rAnrindividualrwhorisrenrolledrinranrMSArplanrisrresponsiblerforrarminimalrdeductiblerofr$
500rindexedrforrinflationr
20. IV.rNon-
networkrprovidersrmustracceptrthersameramountrthatrOriginalrMedicarerwouldrpayrthemra
srpaymentrinrfull.r-rrCORRECTrANSWERS-I,rII.randrIVronly.
21. Mr.rDaviesrisrturningr65rnextrmonth.rHerwouldrlikertorenrollrinrarMedicarerhealthrplanrbutrd
oesrnotrwantrtorberlimitedrinrtermsrofrwhererherobtainsrhisrcare.rWhatrshouldryourtellrhimra
boutrhowrarMedicarerCostrPlanrmightrfitrhisrneeds?r-rrCORRECTrANSWERS-
CostrplanrenrolleesrcanrchoosertorreceiverMedicarercoveredrservicesrunderrtherplan'srbene
fitsrbyrgoingrtorplanrnetworkrprovidersrandrpayingrplanrcost-
sharingrorrmayrreceiverservicesrfromrnon-networkrprovidersrandrpayrcost-
sharingrduerunderrOriginalrMedicare.
22. Mr.rChenrisrenrolledrinrhisremployer'srgrouprhealthrplanrandrwillrberretiringrsoon.rHerwouldrl
ikertorknowrhisroptionsrsincerherhasrdecidedrtordroprhisrretireercoveragerandrisreligiblerforr
Medicare.rWhatrshouldryourtellrhim?r-rrCORRECTrANSWERS-
Mr.rChenrcanrdisenrollrfromrhisremployer-
sponsoredrcoveragertorelectrarMedicarerAdvantagerorrPartrDrplan,rbutrhershouldrrevaluateri
frherreallyrwantsrtordroprhisremployerrcoverage.
23. WhenrsolicitingrreferralsrfromrcurrentrmembersrofranrMArorrPartrDrplan,rwhatrmayryourdo?r
-rrCORRECTrANSWERS-
Enrollmentrperiodr(SEP)rforrbothrMArandrPartrDrduertorarchangerofrresidence?r
24. I.rEdwardr(enrolledrinrMArandrPartrD)rmovesrtorarnewrhomerwithinrthersamerneighborhoodr
inrhisrexistingrplan'srservicerarea.r
25. II.rFionar(enrolledrinrMArandrPartrD)rmovesrcross-
countryrtoranrarearoutsiderherrexistingrplan'srservicerarea.r
26. III.rGilbertrmovesrintorarplanrservicerarearwhererthererisrnowrarPartrDrplanravailablertorhimrfr
omrarservicerarearwherernorPartrDrplanrwasravailable.r
CORRECT ANSWERS GRADED A+
FOR 2026 ASSURED EXAMS
ASSURED EXCEL!!
1. Mr.Gomez notes that a Private Fee for Service (PFFS) plan avaliable in his area has an
attractive preminum. He wants to know if he must use doctors in a network as his
current HMO plan requires him to do. What should you tell him? - CORRECT ANSWERS-
He may receive health care services from any doctor allowed to bill Medicare as long as
he shows the doctor the plan's identification card and the doctor agrees to accept the
PFFS plan's payment terms and conditions, which could include balance billing.
2. Mrs. Lee is discussing with you the possibility of enrolling in a Private Fee- for Service
(PFFS) plan. As part of that discussion, what should you be sure to tell her? - CORRECT
ANSWERS-PFFS plans may choose to offer Part D benefits but are not required to do so.
3. Mrs. Ramos is considering a Medicare Advantage PPO and has questions about which
providers she can go to for her health care. What should you tell her? - CORRECT
ANSWERS-Mrs. Ramos can obtain care from any provider who participates in Original
Medicare but generally will have a higher cost-sharing amount if she sees a provider
who/that is not apart of the PPO network.
4. Mr. McTaggert notes that a Private Fee for-Service (PFFS) plan avaliable in his area has an
attractive premium. He wants to know what makes them different from an HMO or a
PPO. What should you tell him? - CORRECT ANSWERS-Enrollees in a PFFS plan can
obtain care from any provider in the US who accepts Original Medicare, as long as the
provider has a reasonable opportunity to access the plan's terms and conditions and
agrees to accept them.
5. Mr. Castillo, a naturalized citizen, previously enrolled in Medicare Part B but has recently
stopped paying his Part B premium. Mr. Castillo is still covered by Part A. He would like
, to enroll in a Medicare Advantage (MA) plan and is still covered by Part A. What should
you tell him? - CORRECT ANSWERS-He is not eligible to enroll in a Medicare Advantage
plan until he re-enrolls in Medicare Part B.
6. Mr. Sinclar has diabetes and heart trouble and is generally satisified with the care he has
just received under Original Medicare, but he would like to know more about Medicare
Advantage Special Needs Plans (SNPs). What could you tell him? - CORRECT ANSWERS-
SNPs have special programs from enrollees with chronic conditions, like Mr. Sinclair and
they provide prescription drug coverage that could be very helpful as well.
7. Mrs.Davenport enrolled in the ABC Medicare Advantage (MA) plan several years ago.
Her doctor recently confirmed a diagnosis of end-stage renal disease (ESRD). What
options does Mrs.Davenport have regarding her MA plan during the next open
enrollment season? - CORRECT ANSWERS-She may remain in her ABC MA plan or enroll
in a Special Needs Plan (SNP) for individuals sufferinf from ESRD if one is available in her
area.
8. Daniel is a middle-income Medicare beneficiary. He has chronic bronchitis putting him at
severe risk for pneumonia. Otherwise, he has no problems functioning. Which type of
SNP is likely to be most appropriate for him? - CORRECT ANSWERS-C-SNP
9. Mr. Gomez notes that a Private Fee-for Service (PFFS) plan available in his area has an
attractive premium. He wants to know if he must use doctors in a network as his curreny
HMO plan requires him to do. What should you tell him? - CORRECT ANSWERS-He may
receive health care services from any doctor allowed to bill Medicare as long as he
shows the doctor the plan's identification card and the doctor agrees to accept the PFFS
plan's payment terms and conditions, which could include balance billing.
10. Mrs. Ramos is considering a Medicare Advantage PPO and has questions about which
providers she can go to for her health care. What should you tell her? - CORRECT
ANSWERS-Mrs. Ramos can obtain care from any provider who participates in Original
Medicare but generally will have a higher cost-sharing amount if she sees a provider
who/that is not a part of the PPO network.
,11. Mr. Kumar is considering a Medicare Advantage HMO and has questions about his ability
to access providers. What should you tell him? - CORRECT ANSWERS-In most Medicare
Advantage HMOs, Mr. Kumar must generally obtain his services only from providers who
have a contractual relationship with the plan (except in emergency or where care is
unavailable within the network)
12. Mr.Greco is in excellent health, lives in his own home, and has aa sizeable income from
his investments. He has a friend enrolled in a Medicare Advantage Special Needs Plan
(SNP). His friend has mentioned that the SNP charges very low costs sharing amounts
and Mr. Greco would like to join that plan. What should you tell him? - CORRECT
ANSWERS-SNPs limit enrollment to certain subpopulations of beneficiaries. Given his
current situation, he is unlikelt torqualifyrandrwouldrnotrberablertorenrollrinrtherSNP.
13. Dr.rElizabethrBrennanrdoesrnotrcontractrwithrtherPFFSrplanrbutrsheracceptsrtherplan'srterms
randrconditionsrforrpayment.rMaryrRodgersrseesrDr.rBrennanrforrtreatment.rHowrmuchrmay
rDr.rBrennanrcharge?r-rrCORRECTrANSWERS-
Dr.rBrennanrcanrchargerMaryrRodgersrnormorerthanrthercostrsharingrspecifiedrinrtherPFFSrpl
an'srtermsrandrconditionrofrpaymentrwhichrmayrincluderbalancerbillingruprtor15rpercentrofrt
herMedicarerrate.
14. Mrs.Lyonsrisrinrgoodrhealth,rusesrarsinglerprescription,randrlivesrindependentlyrinrherrownrh
ome.rSherisrattractedrbyrtheridearofrmaintainingrcontrolroverrarMedicalrSavingsrAccountr(M
SA)rbutrisrnotrsurerifrtherplanrassociatedrwithrtheraccountrwillrfitrherrneeds.rWhatrspecificrpi
ecerofrinformationraboutrarMedicarerMSArplanrwouldritrberimportantrforrherrtorknow,rpriorr
torenrollingrinrsuchrarplan?r-rrCORRECTrANSWERS-
AllrMSAsrcoverrPartrArandrPartrBrbenefits,rbutrnotrPartrDrprescriptionrdrugrbenefits,rwhichrc
ouldrberobtainedrbyralsorenrollingrinrarseparaterprescriptionrdrugrplan.
15. Mrs.LeerisrdiscussingrwithryourtherpossibilityrofrenrollingrinrarPrivaterFee-for-
Servicer(PFFS)rplan.rAsrpartrofrthatrdiscussion,rwhatrshouldryourbersurertortellrher?r-
rrCORRECTrANSWERS-
PFFSrplansrmayrchoosertorofferrPartrDrbenefitsrbutrarernotrrequiredrtordorso.
, 16. WhichrofrtherfollowingrstatementsrisrcorrectraboutrMedicarerSavingsrAccountr(MSA)rPlans?
r
17. I.rMSAsrmayrhavereitherrarpartialrnetwork,rfullrnetwork,rorrnornetworkrofrproviders
18. II.rMSArplansrcoverrPartrArandrPartrBrbenefitsrbutrnotrPartrDrprescriptionrdrugrbenefits.
19. III.rAnrindividualrwhorisrenrolledrinranrMSArplanrisrresponsiblerforrarminimalrdeductiblerofr$
500rindexedrforrinflationr
20. IV.rNon-
networkrprovidersrmustracceptrthersameramountrthatrOriginalrMedicarerwouldrpayrthemra
srpaymentrinrfull.r-rrCORRECTrANSWERS-I,rII.randrIVronly.
21. Mr.rDaviesrisrturningr65rnextrmonth.rHerwouldrlikertorenrollrinrarMedicarerhealthrplanrbutrd
oesrnotrwantrtorberlimitedrinrtermsrofrwhererherobtainsrhisrcare.rWhatrshouldryourtellrhimra
boutrhowrarMedicarerCostrPlanrmightrfitrhisrneeds?r-rrCORRECTrANSWERS-
CostrplanrenrolleesrcanrchoosertorreceiverMedicarercoveredrservicesrunderrtherplan'srbene
fitsrbyrgoingrtorplanrnetworkrprovidersrandrpayingrplanrcost-
sharingrorrmayrreceiverservicesrfromrnon-networkrprovidersrandrpayrcost-
sharingrduerunderrOriginalrMedicare.
22. Mr.rChenrisrenrolledrinrhisremployer'srgrouprhealthrplanrandrwillrberretiringrsoon.rHerwouldrl
ikertorknowrhisroptionsrsincerherhasrdecidedrtordroprhisrretireercoveragerandrisreligiblerforr
Medicare.rWhatrshouldryourtellrhim?r-rrCORRECTrANSWERS-
Mr.rChenrcanrdisenrollrfromrhisremployer-
sponsoredrcoveragertorelectrarMedicarerAdvantagerorrPartrDrplan,rbutrhershouldrrevaluateri
frherreallyrwantsrtordroprhisremployerrcoverage.
23. WhenrsolicitingrreferralsrfromrcurrentrmembersrofranrMArorrPartrDrplan,rwhatrmayryourdo?r
-rrCORRECTrANSWERS-
Enrollmentrperiodr(SEP)rforrbothrMArandrPartrDrduertorarchangerofrresidence?r
24. I.rEdwardr(enrolledrinrMArandrPartrD)rmovesrtorarnewrhomerwithinrthersamerneighborhoodr
inrhisrexistingrplan'srservicerarea.r
25. II.rFionar(enrolledrinrMArandrPartrD)rmovesrcross-
countryrtoranrarearoutsiderherrexistingrplan'srservicerarea.r
26. III.rGilbertrmovesrintorarplanrservicerarearwhererthererisrnowrarPartrDrplanravailablertorhimrfr
omrarservicerarearwherernorPartrDrplanrwasravailable.r
